Treatment of acute ischemic stroke: from fibrinolysis to neurointervention

J Thromb Haemost. 2015 Jun:13 Suppl 1:S290-6. doi: 10.1111/jth.12971.

Abstract

Thrombolytic therapy with intravenous recombinant tissue plasminogen activator is well established as a beneficial treatment for patients presenting with acute ischemic stroke (AIS). The odds of a favorable clinical outcome (living independently) increase as the time between stroke onset and treatment with IV thrombolysis decreases. However, many patients present with a large clot burden that seldom responds to systemic fibrinolysis. Alternative options include new and emerging endovascular therapies that have recently proven effectiveness at restoring cerebral blood flow to the ischemic brain parenchyma. This review article will briefly outline some of the key evidence for intravenous thrombolysis as well as endovascular therapy for AIS.

Keywords: mechanical thrombolysis; stroke; thrombectomy; thrombolytic therapy; tissue plasminogen activator.

Publication types

  • Review

MeSH terms

  • Animals
  • Brain Ischemia / blood
  • Brain Ischemia / diagnosis
  • Brain Ischemia / therapy*
  • Endovascular Procedures* / adverse effects
  • Fibrinolysis / drug effects
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Hemorrhage / chemically induced
  • Humans
  • Patient Selection
  • Risk Assessment
  • Risk Factors
  • Stroke / blood
  • Stroke / diagnosis
  • Stroke / drug therapy*
  • Thrombolytic Therapy* / adverse effects
  • Time-to-Treatment
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator